Provider Demographics
NPI:1679679500
Name:LECH, AGNIESZKA (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:
Last Name:LECH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 2ND AVE
Mailing Address - Street 2:200
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6244
Mailing Address - Country:US
Mailing Address - Phone:831-582-2100
Mailing Address - Fax:831-582-2190
Practice Address - Street 1:2930 2ND AVE
Practice Address - Street 2:200
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6244
Practice Address - Country:US
Practice Address - Phone:831-582-2100
Practice Address - Fax:831-582-2190
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93023207R00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist